Metabolic and Morphologic Complications of HIV and HAART


•	Synthetic testosterone analogues
•	Several studies demonstrate increases in BCM and nitrogen retention
•	Long-term safety remains unknown
•	Use in women is experimental
•	Use cautiously in patients with liver disease

1. Gold J et al. AIDS. 1996;10:745-52. 2. Bucher G et al. XI International AIDS Conference, 1996. Abstract MoB423 3. Strawford A et al. J Acquir Immune Defic Syndr Hum Retrovirol. 1999;20:137-46. 4. Poles MA et al. 4th Conference on Retroviruses and Opportunistic Infections, 1997. Abstract 695 5. Romeyn M et al. JAMA. 2000;284

• Other anabolic agents, specifically synthetic testosterone analogues commonly referred to as "steroids," have also been used as therapies for HIV-associated wasting.

• Several studies of various steroid preparations have demonstrated increases in body cell mass and nitrogen retention.1-5 Their long-term safety, however, remains unknown.

• Steroid use in women is considered experimental. Androgen deficiency does occur in women with HIV infection, although its contribution to wasting is unknown.6,7 Low doses of testosterone have been safely used in androgen-deficient women with HIV infection and wasting, producing weight gain primarily in the form of fat.8

• The long-term safety and efficacy of anabolic steroids in patients with HIV-associated wasting is unknown. Clinicians should monitor long-term side effects and drug-drug interactions when using these agents. They should be avoided altogether or used cautiously in patients with liver disease.

References:

1. Gold J, High HA, Li Y et al. Safety and efficacy of nandrolone decanoate for treatment of wasting in patients with HIV infection. AIDS. 1996;10:745-52.

2. Bucher G, Berger DS, Fields-Gardner C et al. A prospective study on the safety and effect of nandrolone decanoate in HIV-positive patients. Program and abstracts of the XI International Conference on AIDS, Vancouver, British Columbia; July 7-12, 1996. Abstract MoB423.

3. Strawford A, Barbieri T, Neese R et al. Effects of nandrolone decanoate therapy in borderline hypogonadal men with HIV-associated weight loss. J Acquir Immune Defic Syndr Hum Retrovirol. 1999;20:137-46.

4. Poles MA, Meller JA, Linn A et al. Oxandrolone as a treatment for AIDS-related weight loss and wasting. Program and abstracts of the 4th Conference on Retroviruses and Opportunistic Infections; January 22-26, 1997. Abstract 695.

5. Romeyn M, Gunn N III. Resistance exercise and oxandrolone for men with HIV-related weight loss. JAMA. 2000;284.

6. Grinspoon S, Corcoran C, Miller K, et al. Body composition and endocrine function in women with acquired immunodeficiency syndrome wasting. J Clin Endocrinol Metab. 1997;82:1332-7.

7. Sinha-Hikim I, Arver S, Beall G et al. The use of a sensitive equilibrium dialysis method for the measurement of free testosterone levels in healthy, cycling women and in human immunodeficiency virus-infected women. J Clin Endocrinol Metab. 1998;83:1312-8.

8. Miller K, Corcoran C, Armstrong C et al. Transdermal testosterone administration in women with acquired immunodeficiency wasting: a pilot study. J Clin Endocrinol Metab. 1998;83:2717-25.